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Thyroid storm in pediatrics: a systematic review

  • Daniela Aguilar Abisad ORCID logo EMAIL logo , Eva Maria Glenn Lecea , Andrea Montano Ballesteros , Guido Alarcon , Alejandro Diaz and Pedro Pagan-Banchs
Published/Copyright: November 2, 2022
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 36 Issue 3

Abstract

Objectives

Thyroid storm (TS) is an uncommon but severe manifestation of hyperthyroidism and an endocrine emergency, as it is fatal if it goes unrecognized. In pediatrics, the current literature is limited to case reports and case series. Current knowledge is extrapolated from adult data. This systematic review aims to present the epidemiology, most common etiologies, clinical presentation, and most accepted standard of care of TS in children. We aim to raise awareness of hyperthyroidism in the pediatric community.

Content

The databases used were PubMed, google scholar, and LILACS, with the search terms “thyroid storm” AND “pediatrics”. Studies included case reports and case series in English and Spanish from patients between the ages of 0–21 years with clinical features consistent with a diagnosis of TS based on ATA 2016, with or without reported scale scores, published between 2000 and 2022. Variables such as ethnicity, etiology, possible triggers, clinical features, and management components were analyzed and presented.

Summary

We analyzed data from 45 patients. Their mean age was 11.25 years. The majority of them were from Asia (26%). The most common clinical features were sinus tachycardia (86.7%) and fever (64%), followed by altered mental status (46%) and diarrhea (31%). Graves’ disease was the most common underlying condition, and infection the most common precipitant. Thirty one percent of patients received treatment with four components; however morbidity and mortality were not clinically significant with those who did not. TS has a heterogeneous presentation with multisystemic involvement. The most common symptoms in this review were fever, tachycardia, diarrhea, and altered mental status.

Outlook

Further studies may be needed to best standardize the diagnosis and management of TS in children. Qualitative studies are needed to best assess the delay in diagnosis of hyperthyroidism and how this may impact prognosis in case patients were to develop TS.

Keywords: diarrhea; hyperthermia; hyperthyroidism; methimazole; pediatrics; propylthiuracil; tachycardia; thyroid storm
Corresponding author: Daniela Aguilar Abisad, Pediatrics, Nicklaus Children's Hospital, Miami, FL, USA, E-mail:

Acknowledgments

Elizabeth G. Lipman Diaz, PhD, ARNP, CPNP for technical editing, language editing, and proofreading.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Not applicable.

  5. Ethical approval: Not applicable.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/jpem-2022-0309).

Received: 2022-06-18
Accepted: 2022-10-18
Published Online: 2022-11-02
Published in Print: 2023-03-28

© 2022 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Thyroid – what is a healthy thyroid function test?
  4. Review
  5. Thyroid storm in pediatrics: a systematic review
  6. Opinion Paper
  7. DSD/intersex: historical context and current perspectives
  8. Original Articles
  9. Predictive value of 6 h postoperative parathyroid hormone level on permanent hypoparathyroidism in pediatric total thyroidectomy: a pilot study
  10. Evaluation of a nurse-led counselling intervention on selected outcome variables for parents of children with congenital adrenal hyperplasia
  11. The relationship between estrogen and subsequent growth restriction among adolescents with heavy menstrual bleeding at menarche
  12. An open-label extension of a phase 2 dose-finding study of once-weekly somatrogon vs. once-daily Genotropin in children with short stature due to growth hormone deficiency: results following 5 years of treatment
  13. Normal bone density but altered geometry in girls with Turner syndrome
  14. Newborn screening for inborn errors of metabolism in a northern Chinese population
  15. Evaluation of serum telomerase activity in normal-weight young girls with polycystic ovary syndrome and its relation to metabolic parameters
  16. Early onset of puberty during COVID-19 pandemic lockdown: experience from two Pediatric Endocrinology Italian Centers
  17. Using change in predicted adult height during GnRH agonist treatment for individualized treatment decisions in girls with central precocious puberty
  18. Short Communications
  19. Long-term experience with the use of a single histrelin implant beyond one year in patients with central precocious puberty
  20. Relationships among biochemical measures in children with diabetic ketoacidosis
  21. Case Reports
  22. Hyperthyroidism in McCune–Albright Syndrome – a case report
  23. Sexual precocity in the setting of parental use of a compounded testosterone cream: case report and review of the literature
  24. Intracardiac thrombosis following intravenous zoledronate treatment in a child with steroid-induced osteoporosis
  25. Identification of a novel mutation in the ALDOB gene in hereditary fructose intolerance
https://doi.org/10.1515/jpem-2022-0309
Keywords for this article
diarrhea; hyperthermia; hyperthyroidism; methimazole; pediatrics; propylthiuracil; tachycardia; thyroid storm

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Thyroid – what is a healthy thyroid function test?
  4. Review
  5. Thyroid storm in pediatrics: a systematic review
  6. Opinion Paper
  7. DSD/intersex: historical context and current perspectives
  8. Original Articles
  9. Predictive value of 6 h postoperative parathyroid hormone level on permanent hypoparathyroidism in pediatric total thyroidectomy: a pilot study
  10. Evaluation of a nurse-led counselling intervention on selected outcome variables for parents of children with congenital adrenal hyperplasia
  11. The relationship between estrogen and subsequent growth restriction among adolescents with heavy menstrual bleeding at menarche
  12. An open-label extension of a phase 2 dose-finding study of once-weekly somatrogon vs. once-daily Genotropin in children with short stature due to growth hormone deficiency: results following 5 years of treatment
  13. Normal bone density but altered geometry in girls with Turner syndrome
  14. Newborn screening for inborn errors of metabolism in a northern Chinese population
  15. Evaluation of serum telomerase activity in normal-weight young girls with polycystic ovary syndrome and its relation to metabolic parameters
  16. Early onset of puberty during COVID-19 pandemic lockdown: experience from two Pediatric Endocrinology Italian Centers
  17. Using change in predicted adult height during GnRH agonist treatment for individualized treatment decisions in girls with central precocious puberty
  18. Short Communications
  19. Long-term experience with the use of a single histrelin implant beyond one year in patients with central precocious puberty
  20. Relationships among biochemical measures in children with diabetic ketoacidosis
  21. Case Reports
  22. Hyperthyroidism in McCune–Albright Syndrome – a case report
  23. Sexual precocity in the setting of parental use of a compounded testosterone cream: case report and review of the literature
  24. Intracardiac thrombosis following intravenous zoledronate treatment in a child with steroid-induced osteoporosis
  25. Identification of a novel mutation in the ALDOB gene in hereditary fructose intolerance
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